Actemra

Indicated For

systemic juvenile idiopathic arthritis (sJIA), rheumatoid arthritis, polyarticular juvenile idiopathic arthritis (pJIA), systemic sclerosis-associated interstitial lung disease (SSc-ILD), COVID-19

About This Medication

# Genentech Patient Foundation Guide: How to Get Actemra at Low or No Cost ## About This Program The Genentech Patient Foundation is a patient assistance program designed to help uninsured and underinsured patients access Actemra (tocilizumab) at no cost or reduced cost. Actemra is a biologic medication used to treat several serious conditions including rheumatoid arthritis, systemic juvenile idiopathic arthritis, polyarticular juvenile idiopathic arthritis, systemic sclerosis-associated interstitial lung disease, and COVID-19. ## What Is Actemra? Actemra is an interleukin-6 (IL-6) receptor inhibitor—a type of biologic medication that helps reduce inflammation in the body. Your doctor has determined that Actemra may help manage your condition and improve your quality of life. Because Actemra is a biologic medication, it can be expensive, which is why this patient assistance program exists. ## Who Can Apply? You may be eligible for the Genentech Patient Foundation program if you meet ALL of these criteria: **Insurance Status:** - You are uninsured, OR - You are underinsured (your insurance doesn't cover Actemra adequately), OR - You are a Medicare patient who is ineligible for the co-pay assistance program **Income Requirements:** Your household income must not exceed 400% of the Federal Poverty Level (FPL). For individual applicants, this means an income threshold of $50,000 per year. ### Income Eligibility Table by Household Size (400% FPL) | Household Size | Maximum Annual Income | |---|---| | 1 person | $50,000 | | 2 people | $67,600 | | 3 people | $85,200 | | 4 people | $102,800 | | 5 people | $120,400 | | 6 people | $138,000 | | 7 people | $155,600 | | 8+ people | $173,200 | *Note: These income limits are based on 400% FPL guidelines. Contact the program directly for the most current thresholds.* ## What Documents You'll Need Before you start your application, gather the following documents: 1. **Proof of Income** - Recent tax return, W2 forms, recent pay stubs, or a signed statement of income from your employer 2. **Proof of Residency** - Recent utility bill, lease agreement, or other official document showing your current address 3. **Prescription** - A current prescription from your doctor for Actemra 4. **Insurance Information** - Details about your current insurance status (including policy numbers if you have coverage) 5. **Completed Application Form** - Available from the Genentech Patient Foundation ## Step-by-Step Application Instructions ### Step 1: Gather Your Documents Collect all the documents listed above. Make copies if you'll be mailing your application, or have them ready if you're applying online or by phone. ### Step 2: Choose Your Application Method You can apply in multiple ways: - **Online:** Visit https://www.gene.com/patients/patient-foundation - **Phone:** Call (800) 755-4008 and speak with a program representative - **Mail:** Request an application form and mail it with your documents ### Step 3: Complete the Application Fill out all sections of the application form completely and accurately. Provide: - Your personal and household information - Your income details - Your insurance status - Your doctor's prescription - Proof documents as required If you're applying by phone, a representative will guide you through the process step-by-step. ### Step 4: Submit Your Application If applying online or by mail, ensure all documents are included. If applying by phone, the representative will confirm what information they need. ### Step 5: Wait for Approval The Genentech Patient Foundation typically processes applications within 2-4 weeks. You will be notified of the decision by mail, phone, or email. ### Step 6: Receive Your Medication Once approved, your medication will be shipped directly to your doctor's office. Your doctor's staff will contact you when it arrives and provide instructions for treatment. ## What Happens If You're Approved? If approved, you may receive Actemra at no cost or at a significantly reduced cost, depending on your specific situation. The medication will be shipped to your prescribing physician's office, not directly to your home. ## Important: Annual Reauthorization Required Your assistance is not permanent. You must reapply and be reauthorized **every year** to continue receiving assistance through this program. The Genentech Patient Foundation will remind you when it's time to renew, but it's important to keep track of your renewal date. ## Additional Savings Options If you have insurance that covers Actemra but you're struggling with co-pays: - **Actemra Savings Card:** Visit https://www.actemra.com/ra/financial-support/assistance-options.html to see if you qualify for a co-pay assistance card that could reduce your out-of-pocket costs to as little as $5 per prescription. ## What If Your Application Is Denied? If you're denied assistance, you have options: 1. **Ask Why:** Contact the program to understand the specific reason for denial. Sometimes it's a simple fix (missing document, calculation error). 2. **Reapply:** If your circumstances have changed, you may reapply. 3. **Explore Alternatives:** Discuss with your doctor other treatment options, discuss payment plans with your pharmacy, or look into state pharmaceutical assistance programs. 4. **Appeal:** Ask if the program has an appeal process for denied applications. ## How to Contact the Program **Genentech Patient Foundation** - **Phone:** (800) 755-4008 - **Website:** https://www.gene.com/patients/patient-foundation - **Hours:** Typically Monday-Friday, business hours (call for specific times) Have your prescription and insurance information ready when you call. ## Important Legal Information This guide provides general information about the Genentech Patient Foundation program based on current eligibility criteria. However, program details, income limits, and requirements may change. Always verify current information by contacting the program directly or visiting their official website. This information does not guarantee approval or coverage. Each application is reviewed individually based on current program guidelines and your specific circumstances. ## Summary The Genentech Patient Foundation exists to help patients who cannot otherwise afford Actemra. If you meet the eligibility requirements and have the necessary documentation, you can apply relatively quickly and potentially receive your medication within a month. Don't let cost concerns prevent you from getting the treatment your doctor believes you need—apply today. Remember: Your doctor's office may also have resources and information about this program. Don't hesitate to ask your healthcare provider's financial counselor or patient advocate for assistance with the application process.

Program information last verified: March 25, 2026